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  #121  
Old 10-30-2019, 11:22 AM
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Interesting commentary, and that's frustrating to hear about the ASOP 45 question being based on the appendix.

I'd have to see the actual question because a lot of the appendices on the ASOPs are somewhat recaps of the information presented in the ASOP but in a little simpler, more applicable way. So we'll see what the wording says, but I wonder if they'll try to justify by saying that the actual information may still be on the syllabus even though they pulled the problem set-up from the appendix. (Of course, I haven't seen the problem, so that's all I can really say about it.)

Hopefully for the TIA students, they watched the ASOP video until the end because I actually go through the entire appendix as practice and do those problems piece by piece.
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  #122  
Old 10-30-2019, 11:23 AM
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Side note - I'm glad to hear the exam has recently had more than four questions, as that does spread out the mix of questions a bit more.

Surprising that they didn't have anything at all on RBC or reinsurance, though.
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  #123  
Old 10-30-2019, 11:24 AM
ShouldHaveDoneCompSci ShouldHaveDoneCompSci is offline
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Quote:
Originally Posted by BigBlackBen View Post
the savings come from reduced utilization in the measurement period vs trended baseline
Is that specifically within inpatient admits? I thought that admits/member was constant between baseline/measurement. More importantly, one of the "principles" of DM measurement is validation against your financials, so I think I should still get points for saying "total cost went up 15%, so the claim you saved me 2.5% on total cost is unlikely."

I forgot to mention cost of the program though, that's obviously something they were looking for.
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  #124  
Old 10-30-2019, 11:39 AM
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Quote:
Originally Posted by ShouldHaveDoneCompSci View Post
Is that specifically within inpatient admits? I thought that admits/member was constant between baseline/measurement. More importantly, one of the "principles" of DM measurement is validation against your financials, so I think I should still get points for saying "total cost went up 15%, so the claim you saved me 2.5% on total cost is unlikely."

I forgot to mention cost of the program though, that's obviously something they were looking for.
Admit/member were right on top of eachother. The savings was generated when you apply the 6% trend to the baseline.
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  #125  
Old 10-30-2019, 11:40 AM
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Quote:
Originally Posted by ShouldHaveDoneCompSci View Post
Is that specifically within inpatient admits? I thought that admits/member was constant between baseline/measurement. More importantly, one of the "principles" of DM measurement is validation against your financials, so I think I should still get points for saying "total cost went up 15%, so the claim you saved me 2.5% on total cost is unlikely."

I forgot to mention cost of the program though, that's obviously something they were looking for.
The admits/member DID stay constant, however a utilization trend was provided. So you really need to compare Prior Admits/Member X (1+UtilTrend) to the New Admits/Member - which is where the savings comes into play.

I'm sure I could have done a better "commentary" regarding the Vendor's Estimate...I really just calculated the % savings and moved on.
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  #126  
Old 10-30-2019, 11:51 AM
ShouldHaveDoneCompSci ShouldHaveDoneCompSci is offline
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Originally Posted by trondogss View Post
Admit/member were right on top of eachother. The savings was generated when you apply the 6% trend to the baseline.
Oh right of course. I give the SOA too much credit. If a vendor actually showed me that data and made that claim I'd laugh them out of my office, but I suppose reality doesn't play into these exams
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  #127  
Old 10-30-2019, 11:58 AM
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What did y'all put for risk controls the CO-OP should implement related to underwriting, pricing, and claims management risk?
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  #128  
Old 10-30-2019, 12:10 PM
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Given it was them interested in using ERM, I talked about risk appetite, tolerance, limits and explained how one can attempt to mitigate after limits are breached in hopes to reign in before risks get close to tolerance levels.

I could see how that answer is not appropriate as well.
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  #129  
Old 10-30-2019, 12:16 PM
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What did y'all put for risk controls the CO-OP should implement related to underwriting, pricing, and claims management risk?
There's a whole section on risk controls in the ERM Ratings Direct reading. Of course this wasn't something I chose to memorize :/.

I'm feeling worse and worse about this exam the more I talk about it...
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  #130  
Old 10-30-2019, 12:28 PM
PoisedGiraffe PoisedGiraffe is offline
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Quote:
Originally Posted by cpkz View Post
What did y'all put for risk controls the CO-OP should implement related to underwriting, pricing, and claims management risk?
I ended up making a notecard for this, luckily.


It was things like underwriting controls, staggering renewals for pricing, provider diversity, negotiation power, reinsurance contracts, auditing claim management, etc.

Well, assuming this is actually the list they were looking for....

Last edited by PoisedGiraffe; 10-30-2019 at 12:40 PM..
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